The Medical Advisor is responsible for the clinical aspects of all work performed by the Strategic Managed Care unit (SMC). The purpose of the position is to plan, lead, organize and control the activities of the clinical department within the SMC unit to ensure that expert, evidence-based input and recommendations are made.
Provide clinical oversight on all aspects of work performed by the clinical department within
the SMC unit.
Provide mentorship within the SMC clinical team and lend support to meet deadlines.
Review and assess new and existing clinical policies and protocols from an evidence-based,
clinical and financial impact perspective.
Perform research into funding decisions with the view of developing
innovative reimbursement models and enhancing the appropriateness and cost-effectiveness of funding policies within the managed care environment
In collaboration with the Insight actuaries, interpret healthcare utilisation patterns and
trends with respect to the clinical appropriateness of care.
Conduct reviews of good practice guidelines currently available to ensure that scheme
funding decisions are based on best practice.
Evaluate current healthcare usage trends and compare with local and international sources
for best practice.
Monitor medical literature and use evidence-based principles to review and generate
enhancements in funding protocols.
Review and provide recommendations for reimbursement of new health technologies.
Attend various Scheme forums and provide the expertise needed to give strategic input and
clinical advisory services. Presentations will often be required.
Provide clinical technical support when the Scheme requires expertise in defined areas.
Participate in interdisciplinary committees and in clinical projects/studies within the Scheme
Provide input and support to the Expert Medical Advisory Board.
Provide input and support to the Clinical Committee.
Maintain relationships within the healthcare industry and stay abreast of new developments that impact the medical industry.
Perform tasks timeously, accurately and with the necessary detail in response to issues raised.
Experienceand qualifications required
A MBCHB is required.
At least 5 years’ experience within the South African managed care environment is
At least 5 years’ managerial experience
Strong verbal and written communication skills
Strong analytical and problem solving skills
Ability to conduct research using a variety of academic and market-related resources
Good organisational ability and being ability to meet tight deadlines
Accuracy and attention to detail
Must be able to work in a team
Be able to speak, write, read and comprehend fluently in English.
Ability to communicate in any other of the 11 South African official languages will be an advantage e.g. Afrikaans, Zulu, Xhosa.
Proficiency in the following programmes is required:
§ MS Word
§ MS Excel
§ MS Outlook
§ MS Powerpoint